Higher brain dysfunction - From the administrative viewpoint

The "higher brain dysfunction" illustrates various cognitive and behavioral consequences resulted from organic brain damage - attention deficits, memory disorders, executive dysfunction, and disorders of emotion and social communication. These deficits are hard to be visible externally, so patients with such "higher brain problems" are difficult to be appropriately evaluated and treated even in psychiatry service. The patients who have reached to a chronic phase and whose treatments are terminated have been able to live some stable life at home, but exhibit many difficulties in social life, so they remain unemployment. In Japan, the Ministry of Health, Labour and Welfare has started the project for the investigation and the support of patients with higher brain dysfunction since 2001. In this article, first, the diagnostic criterion for "higher brain dysfunction" is presented. Secondly, each cognitive and behavioral disorder is reviewed. Then, the present state and future issues are indicated. We would emphasize that for the patients with such higher brain dysfunctions, the appropriate treatments and services from the injury to the employment should be ensure, and that multi-disciplinary collaboration including medical doctors and paramedical staff - not only occupational therapist (OT), physical therapist (PT), speech therapist (ST), and clinical psychotherapist but also the experts at neuropsychology and at applied behavior analysis is crucial for overcome patients' problems.